Recent Breastfeeding Research Articles

Which Has a Greater Impact on the Recurrence in Young Breast Cancer Patients: Recent Childbirth or Recent Breastfeeding?

Purpose This study explored the effects of recent childbirth and recent breastfeeding on the risk of recurrence in patients with postpartum breast cancer (PPBC). Materials and Methods A bidirectional cohort study was conducted in the First Affiliated Hospital of Nanjing Medical University. 1013 young female breast cancer patients between May 2003 and October 2019 were enrolled. Breast cancer cases were grouped according to the time between giving birth or weaning and diagnosis. The end point of the analysis was disease-free survival (DFS). Results Breast cancer patients diagnosed within 2 years after parturition showed more tumor characteristics that represented poor prognosis and remained at an increased risk for recurrence, even after adjusting for confounding factors (HR = 1.83, p=0.035). When the analysis was limited to patients with ER positive or histological grades I and II, they had a higher risk of recurrence. When weaning was used as the grouping node, patients diagnosed within 2 years after weaning did not show a higher risk of recurrence after adjustment, even when analysis was nearly limited to ER-positive patients. Conclusion Recent reproductive history is an independent prognostic factor and seems to have a stronger impact on breast cancer with lower malignancy. In addition, the effect of recent childbirth on the recurrence of young breast cancer is significantly stronger than that of recent breastfeeding.

Evaluation of a breastmilk hand expression toolkit: the M.I.L.K survey study

BackgroundBreastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit.MethodsIndividuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed and completed a two-part survey that consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participants were recruited electronically through social media and posters were circulated in antenatal and postnatal care settings in Ottawa, Canada between November 2020 and February 2021.ResultsOf the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%).ConclusionsThe BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to teach participants correctly BMHE.

A More Comfortable Method of Skin Prick Testing in Children Ages 0-2 to Decrease Symptoms of Pain

BackgroundSkin prick testing (SPT) is the best initial diagnostic method for individuals of all ages who have potential allergies. AimWe aimed to investigate if recent breastfeeding has any effect on reducing the pain of children before SPT. DesignProspective, randomized, single-blinded study. SettingsAcademic hospital specialized in pediatrics. Participants/SubjectsSixty-four out of seventy-five children requiring SPT within ages 0-2 were included. MethodsAll participants in this study were breastfed children, and that group assignment randomized them to the control group (n = 32) if children breastfed 30-90 min. prior to arriving for SPT, and study group of children (n = 32) who were also breastfed 30-90 minutes prior to arriving for SPT who were then breastfed again just prior to the beginning of the SPT. The FLACC pain scale was used to test the sensitivity of all children for pain before, during, and 15 minutes after the SPT. The effect of breastfeeding on the pain score and the duration of crying were compared among groups. ResultsBoth groups were similar according to age, gender, and other socio-demographic characteristics (p > .05). The percentage of children that cried during SPT was significantly higher in the control group than the study group (p = .002). The FLACC pain scale values were significantly lower in the study group (p < .001). ConclusionRecent breastfeeding before SPT is correlated with less crying by possibly reducing the perceived pain of children ages 0-2.

Association Between Breastfeeding and Ovarian Cancer Risk

Breastfeeding has been associated with a reduced risk of epithelial ovarian cancer in multiple studies, but others showed no association. Whether risk reduction extends beyond that provided by pregnancy alone or differs by histotype is unclear. Furthermore, the observed associations between duration and timing of breastfeeding with ovarian cancer risk have been inconsistent. To determine the association between breastfeeding (ie, ever/never, duration, timing) and ovarian cancer risk overall and by histotype. A pooled analysis of parous women with ovarian cancer and controls from 13 case-control studies participating in the Ovarian Cancer Association Consortium was performed. Odds ratios (ORs) and 95% CIs of the overall association were calculated using multivariable logistic regression and polytomous logistic regression for histotype-specific associations. All data were collected from individual sites from November 1989 to December 2009, and analysis took place from September 2017 to July 2019. Data on breastfeeding history, including duration per child breastfed, age at first and last breastfeeding, and years since last breastfeeding were collected by questionnaire or interview and was harmonized across studies. Diagnosis of epithelial ovarian cancer. A total of 9973 women with ovarian cancer (mean [SD] age, 57.4 [11.1] years) and 13 843 controls (mean [SD] age, 56.4 [11.7] years) were included. Breastfeeding was associated with a 24% lower risk of invasive ovarian cancer (odds ratio [OR], 0.76; 95% CI, 0.71-0.80). Independent of parity, ever having breastfed was associated with reduction in risk of all invasive ovarian cancers, particularly high-grade serous and endometrioid cancers. For a single breastfeeding episode, mean breastfeeding duration of 1 to 3 months was associated with 18% lower risk (OR, 0.82; 95% CI, 0.76-0.88), and breastfeeding for 12 or more months was associated with a 34% lower risk (OR, 0.66; 95% CI, 0.58-0.75). More recent breastfeeding was associated with a reduction in risk (OR, 0.56; 95% CI, 0.47-0.66 for <10 years) that persisted for decades (OR, 0.83; 95% CI, 0.77-0.90 for ≥30 years; P for trend = .02). Breastfeeding is associated with a significant decrease in risk of ovarian cancer overall and for the high-grade serous subtype, the most lethal type of ovarian cancer. The findings suggest that breastfeeding is a potentially modifiable factor that may lower risk of ovarian cancer independent of pregnancy alone.

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort.

.The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function.

Symmetry: the key to diagnosing propeller strike injuries in sea mammals

The fresh carcass of a neonatal Indo-Pacific bottlenose dolphin (Tursiops aduncus) was recovered from a suburban beach near Adelaide, South Australia, by officers of the Australian Marine Wildlife Research and Rescue Organisation (AMWRO). The carcass was incomplete with loss of the tail and three deep parallel incised/chop wounds to the torso and tail (Fig. 1). At necropsy the carcass was that of an otherwise healthy Indo-Pacific bottlenose dolphin neonate of around 1–2 weeks of age. The animal was normally formed and well nourished, with milk in its mouth and stomach indicating that recent breast feeding had occurred. Frothy white foam was present in the upper airway. The most significant findings consisted of a series of four curvilinear parallel incised/chop wounds predominately to the right side of the body (Fig. 2). The most rostral injury was a clean incised wound of the upper back and right side of the chest which shelved into paraspinal muscles (Fig. 3). No major vessels had been damaged and the chest cavity had not been opened. Within the chest cavity, however, the deepest part of the chop wound was associated with fracture-dislocation of the midthoracic spine (Fig. 4) with spinal cord transaction. There were also fractures of the posterior aspects of the first to sixth ribs on the right side with fresh paravertebal soft tissue hemorrhage bilaterally. Thoracic organs and vessels were intact. Fifty-nine centimeters caudal to this was a second incised/chop wound which passed from the right side through the anterior aspect of the dorsal fin (Figs. 1, 2). Although no body cavities or major vessels had been opened the wound shelved caudally with fracturing of the underlying spine and adjacent fresh interstitial hemorrhage. Caudal to this was a deep curved incised wound that also shelved caudally and extended into paravertebral muscles with a chopping injury to the lateral aspect of the vertebral bodies, with underlying fractures. The final injury consisted of amputation of the tail (Fig. 5). There were no congenital defects, underlying organic diseases or parasitic infestations identified that could have caused or contributed to death. Death was, therefore, due to multiple incised/chop wounds typical of boat propeller injuries with subsequent exsanguination. Amputation of the tail and transaction of the mid thoracic spinal cord would have also have prevented the animal from swimming.

Reproductive history and overweight in Guatemalan women

Having children has been associated with maternal depletion in poor societies and obesity in developed countries, a conclusion reached using national survey data with limited indicators. We examined the relationship between reproduction and overweight (body mass index > 25kg/m2)in Guatemalan women ( N=505) using complete reproductive histories (number of pregnancies, lifetime years of full and partial breastfeeding (BF)). We compared these results to those obtained with typical indicators used in national surveys: live births (LB) and mo of BF in last 5 y (recent BF) (i.e. partial indicators). Using logistic regression, controlling for sociodemographic confounders, we found a strong, significant relationship between number of pregnancies and overweight, odds ratio (OR) = 4.54 (95% CI 2.05, 10.09), comparing women with > 4 pregnancies to women with 1 pregnancy. Neither lifetime years of full nor partial BF were significantly related to overweight. LB showed a similar, but weaker relationship, OR = 2.44 (1.21, 4.92). Recent BF > 24 mo was protective from overweight compared to 1–12 mo: OR = 0.44 (0.22, 0.89). Number of pregnancies showed a stronger relationship with overweight, since reproductive losses were taken into account; breastfeeding on the other hand was a stronger predictor when considered in the recent past rather than over the lifetime. Results suggest that reproduction may play an important role in overweight in these women. For studies assessing the impact of reproductive behaviors on body composition, complete pregnancy histories and recent breastfeeding would be most useful. Funding: NIH R01 TW005598

Histological dating of timed endometrial biopsy tissue is not related to fertility status

To assess the ability of histological dating to discriminate between women of fertile and infertile couples. The utility of histological dating of endometrium in the evaluation of infertile couples is uncertain. Prospective multicenter study, with subjects randomly assigned to biopsy timing. Criterion standard for infertility was 12 months of unprotected, regular intercourse without conception and for fertility at least one live birth within 2 years. University-based infertility practices. Volunteer subjects (847) recruited at 12 clinical sites participating in the National Institutes of Health-funded Reproductive Medicine Network. Inclusion criteria included ages 20-39 years, regular menstrual cycles, and no hormonal treatment or contraceptive use for 1 month before the study. Fertile controls were excluded if they had a history of infertility, recurrent pregnancy loss, or recent breastfeeding. Subjects underwent daily urinary LH testing. After detection of the LH surge, subjects were randomized to biopsy in the mid (days 21-22) or the late (days 26-27) luteal phase. Pathologists at each site estimated the cycle day based on standard criteria. For the primary analysis, an out-of-phase biopsy was defined as a greater than 2-day delay in the histological maturation of the endometrium. The proportion of out-of-phase biopsies in fertile and infertile women was compared using logistic regression models with age at randomization as a covariate. Comparisons were also made between fertile vs. infertile at the midluteal or late luteal phase time points. Biopsies were evaluated (301 mid and 318 late; N = 619). Out-of-phase biopsy results poorly discriminated between women from fertile and infertile couples in either the midluteal (fertile: 49.4%, infertile: 43.2%) or late luteal phase (fertile: 35.3%, infertile 23.0%). Results did not substantially differ using alternative definitions of "out-of-phase" or standardized cycle day. Histological dating of the endometrium does not discriminate between women of fertile and infertile couples and should not be used in the routine evaluation of infertility.

Breast feeding practices in relation to endometrial cancer risk, USA.

Breast feeding is associated with reduced estrogen, a profile that should be associated with decreased endometrial cancer incidence. We analyzed data from a population-based case-control study of Wisconsin women to evaluate the relation between lactation and endometrial cancer risk. Cases (n = 586) were identified from a statewide tumor registry; controls (n = 1653) were selected randomly from driver's license lists and Medicare beneficiary files. Breast feeding practices and other factors were ascertained by telephone interview. Compared with parous women who did not breast feed, the multivariate relative risk for women who breast fed for at least 2 weeks was 0.90 [95% confidence interval (CI) 0.72-1.13]; increasing duration was not strongly associated with risk of disease (p for trend 0.4). More recent breast feeding was associated with significantly reduced risks. The relative risk for lactation within the recent three decades was 0.58 (95% CI 0.36-0.96) and for first breast feeding at age 30 or greater was 0.50 (95% CI 0.28-0.90). There was a suggestion that risk was increased in women who used lactation suppressant hormones--usually estrogens--more recently (p = 0.1) or at a later age (p = 0.1). This study suggests that, like breast cancer, endometrial cancer is modestly inversely associated with lactation.